Intensive care for infants and children in Haiti in April 2010*

Arnim, Amélie von Saint André-von; Brogan, Thomas V.; Hertzig, Jeremy S.; Kim, Kihan; Wurm, Gwen; Roberts, Joan; Fink, Ericka L.

doi:10.1097/pcc.0b013e318219268d

Cited by 5 publications

(5 citation statements)

References 18 publications

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“…2 ). Therefore, most low-income countries had no literature on ICU capacity, or described ICUs that did not meet our inclusion criteria, such as relief or military hospitals [ 12 , 13 ].…”

Section: Resultsmentioning

confidence: 99%

Intensive Care Unit Capacity in Low-Income Countries: A Systematic Review

2015

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PurposeAccess to critical care is a crucial component of healthcare systems. In low-income countries, the burden of critical illness is substantial, but the capacity to provide care for critically ill patients in intensive care units (ICUs) is unknown. Our aim was to systematically review the published literature to estimate the current ICU capacity in low-income countries.MethodsWe searched 11 databases and included studies of any design, published 2004-August 2014, with data on ICU capacity for pediatric and adult patients in 36 low-income countries (as defined by World Bank criteria; population 850 million). Neonatal, temporary, and military ICUs were excluded. We extracted data on ICU bed numbers, capacity for mechanical ventilation, and information about the hospital, including referral population size, public accessibility, and the source of funding. Analyses were descriptive.ResultsOf 1,759 citations, 43 studies from 15 low-income countries met inclusion criteria. They described 36 individual ICUs in 31 cities, of which 16 had population greater than 500,000, and 14 were capital cities. The median annual ICU admission rate was 401 (IQR 234-711; 24 ICUs with data) and median ICU size was 8 beds (IQR 5-10; 32 ICUs with data). The mean ratio of adult and pediatric ICU beds to hospital beds was 1.5% (SD 0.9%; 15 hospitals with data). Nepal and Uganda, the only countries with national ICU bed data, had 16.7 and 1.0 ICU beds per million population, respectively. National data from other countries were not available.ConclusionsLow-income countries lack ICU beds, and more than 50% of these countries lack any published data on ICU capacity. Most ICUs in low-income countries are located in large referral hospitals in cities. A central database of ICU resources is required to evaluate health system performance, both within and between countries, and may help to develop related health policy.

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“…2 ). Therefore, most low-income countries had no literature on ICU capacity, or described ICUs that did not meet our inclusion criteria, such as relief or military hospitals [ 12 , 13 ].…”

Section: Resultsmentioning

confidence: 99%

Intensive Care Unit Capacity in Low-Income Countries: A Systematic Review

2015

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“…Following the earthquake, Project Medishare admitted nine infants and 20 children to neonatal and pediatric intensive care units, respectively, at a Port-au-Prince field hospital 42 . Among these patients, there was one burn injury, one traumatic superior mesenteric artery tear, and two traumatic brain injuries 43 . The only study examining the prevalence of disabilities and access to services among Haitian children was conducted in 2012.…”

Section: Resultsmentioning

confidence: 99%

“…42 Among these patients, there was one burn injury, one traumatic superior mesenteric artery tear, and two traumatic brain injuries. 43 The only study examining the prevalence of disabilities and access to services among Haitian children was conducted in 2012. In this report, 2.9% of 656 children under five years of age had an identified disability, and these children were less likely to be in school and had more limitations and restrictions on activity than control group children.…”

Section: Nutrition and Food Securitymentioning

confidence: 99%

Health Outcomes for Children in Haiti Since the 2010 Earthquake: A Systematic Review

Dube

Moffatt

Davison

et al. 2017

Prehosp. Disaster med.

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Future health programs in Haiti should focus on provision of clean water, sanitation, and other measures to prevent infectious diseases. Mental health programming and services for children also appear to be greatly needed, and food insecurity/malnutrition must be addressed if children are to lead healthy, productive lives. Given the burden of injury after the 2010 earthquake, further research on long-term disabilities among children in Haiti is needed. Dube A , Moffatt M , Davison C , Bartels S . Health outcomes for children in Haiti since the 2010 earthquake: a systematic review. Prehosp Disaster Med. 2018;33(1):77-88.

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“…Limitation of care decisions were made in the setting of cardiac arrest or respiratory failure necessitating intubation in children with chronic disease. The delivery of quality ICU care was challenging, but was most successful and beneficial for otherwise healthy children who presented with early, acute, reversible disease ( 74 ). In South Africa, in an attempt to provide a reasonable process for fair and equitable utilization of scarce resources, the local PICU team at Red Cross War Memorial Hospital developed explicit admission exclusion criteria (Table 1 ) ( 75 ).…”

Section: Ethics Of Pediatric Critical Care In Resource-limited Countrmentioning

confidence: 99%

A Review of Pediatric Critical Care in Resource-Limited Settings: A Look at Past, Present, and Future Directions

et al. 2016

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Fifteen years ago, United Nations world leaders defined millenium development goal 4 (MDG 4): to reduce under-5-year mortality rates by two-thirds by the year 2015. Unfortunately, only 27 of 138 developing countries are expected to achieve MDG 4. The majority of childhood deaths in these settings result from reversible causes, and developing effective pediatric emergency and critical care services could substantially reduce this mortality. The Ebola outbreak highlighted the fragility of health care systems in resource-limited settings and emphasized the urgent need for a paradigm shift in the global approach to healthcare delivery related to critical illness. This review provides an overview of pediatric critical care in resource-limited settings and outlines strategies to address challenges specific to these areas. Implementation of these tools has the potential to move us toward delivery of an adequate standard of critical care for all children globally, and ultimately decrease global child mortality in resource-limited settings.

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Intensive care for infants and children in Haiti in April 2010*

Cited by 5 publications

References 18 publications

Intensive Care Unit Capacity in Low-Income Countries: A Systematic Review

Intensive Care Unit Capacity in Low-Income Countries: A Systematic Review

Health Outcomes for Children in Haiti Since the 2010 Earthquake: A Systematic Review

A Review of Pediatric Critical Care in Resource-Limited Settings: A Look at Past, Present, and Future Directions

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